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Did the Affordable Care Act Make Health Care More Affordable?

The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees. KFF’s Cynthia Cox examines the ACA’s record and the broader underlying question it raises: what’s a fair price for Americans people to pay for health care?

The ACA MarketplaceS

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

The Average Marketplace Deductible Grew by About $1,000 Per Person in 2026, With More Enrollees Shifting to Higher-Deductible Plans as Enhanced Tax Credits Expired

The average Affordable Care Act (ACA) Marketplace deductible experienced the steepest increase in history—growing by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired, according to a new KFF analysis. After the enhanced tax credits ended, many Marketplace shoppers shifted toward lower-premium, higher-deductible plans.

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  • Tuve cobertura del mercado en 2025 y tengo que conciliar mis impuestos de este año. ¿Cuál es el máximo que tendría que reembolsar al IRS?

    FAQs

    Para el año fiscal 2025, si subestimó sus ingresos y recibió un subsidio para las primas anticipado mayor al que le correspondía, deberá reembolsar la diferencia entre el monto del crédito fiscal recibido y el monto al que tenía derecho. Sin embargo, si sus ingresos son inferiores a cuatro veces (400%) el nivel federal de pobreza, existen límites en dólares sobre el monto que deberá reembolsar para créditos pagados a las aseguradoras en su nombre.…

  • Calculo que mis ingresos el próximo año serán muy bajos, así que necesito pagar por adelantado todo el subsidio para las primas. Si, para fin de año, resulta que mis ingresos anuales fueron incluso meno...

    FAQs

    No, el monto final de su subsidio para las primas se determinará en base a sus ingresos del año, según lo declarado en su declaración de impuestos. El hecho de que haya sido menor de lo esperado no significa que tenga que devolver el subsidio que recibió por adelantado, incluso si hubiera podido calificar para Medicaid. De hecho, el monto final de su crédito probablemente sea mayor que la cantidad que recibió por adelantado. (Esto…

  • There is No Drop-Dead Date for an ACA Tax Credit Extension, But Coverage Losses Will Mount as the Clock Ticks

    Quick Insights

    While the Affordable Care Act’s enhanced premium tax credits expired at the end of 2025, there is no absolute drop-dead date for extending them. An extension could happen even after the deadline to sign up for coverage and be made retroactive to January 1. Open enrollment could also be extended to allow people time to change their plans or allow new people to sign up. ACA enrollees would welcome premium relief whenever it comes.

  • No sé cuánto tiempo hace que terminó mi Medicaid. ¿Hay una fecha límite para solicitar la cobertura del mercado?

    FAQs

    Sí, el período especial de inscripción por pérdida de Medicaid o CHIP es de 90 días en la mayoría de los estados. Esto significa que los consumidores tendrán hasta 90 días después de la pérdida de Medicaid o CHIP para inscribirse en el mercado de seguros. Si no solicita la cobertura del mercado dentro de este plazo, podría tener que esperar hasta el próximo período de inscripción abierta para hacerlo. Los estados que administran sus…

  • In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

    News Release

    ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

  • 2024 Medical Loss Ratio Rebates

    Issue Brief

    Insurers estimate they will pay $1.1 billion in Medical Loss Ratio (MLR) rebates in 2024 to select individuals and employers that purchase their health coverage, according to a KFF analysis of preliminary data reported to state regulators. The estimated rebate for 2024 is larger than rebates issued in most prior years. Nearly $12 billion in rebates have been issued since 2012.

  • Did the Affordable Care Act Make Health Care More Affordable?

    Video

    The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees.KFF’s Cynthia Cox examines the ACA's record and the broader underlying question it raises: what's a fair price for Americans people to pay for health care?

  • How Unaffordable is Health Care? 

    Video

    Health care affordability is a top issue for many people. Why and how did care get so expensive? In this three-part video series, KFF experts look at the rising cost of health care in the U.S. from the macro level to the issues facing everyday Americans. Drawing on KFF policy analysis and polling, the videos examine the underlying drivers of health care spending, the true cost of employer sponsored health insurance and whether the Affordable…

  • Health Care Costs Keep Rising … Why and Who Pays?

    Video

    The U.S. spends more on health care than other large, wealthy countries. Concerns about rising costs aren't new, yet somehow we keep paying the bill. In this video, KFF’s Larry Levitt explains how we got here, who bears the consequences and why reining in spending systematically may be central to the next big health care debate. KFF’s Larry Levitt, Executive Vice President for Health Policy, explains how we got here, who bears the consequences and…